title: Extent of lymphadenectomy does not predict survival in patients treated with primary esophagectomy.
abstract: BACKGROUND
  The number of lymph nodes resected and its impact on survival for patients with esophageal cancer remains undefined. Current guidelines recommend extended lymphadenectomy in patients not receiving neoadjuvant therapy. We reviewed our single institutional experience with nodal harvest for esophageal cancer in a non-neoadjuvant therapy setting.
  
  
  METHODS
  Patients who underwent esophagectomy as primary therapy were indentified from a prospectively maintained database consisting of 704 patients who underwent esophagectomy. Patients were stratified by number of lymph nodes (LN) resected: >5, 10, 12, 15, or 20. Survival, clinical, and pathologic parameters were analyzed with Kaplan-Meier curves, chi-square, or Fisher's exact tests where appropriate.
  
  
  RESULTS
  We identified 246 patients who underwent esophagectomy as initial treatment. The mean age was 65 ±10 years. The majority of patients were male (87%). Ivor-Lewis esophagectomy was performed for 71%, minimally invasive esophagectomy for 15%, transhiatal esophagectomy for 12%, and three-field esophagectomy for 2%. At 60 months follow-up, there was no statistically significant difference in overall survival (OS) or disease-free survival (DFS) between patients with < vs. >5 LN resected (p = 0.74 and p = 0.67, respectively) or in the < vs. >10 (p = 0.33, p = 0.11), 12 (p = 0.82, p = 0.90), 15 (p = 0.45, p = 0.79), or 20 (p = 0.72, p = 0.86) resected LN groups. Patients were then subdivided into node-positive and node-negative cohorts and stratified by nodal harvest. In the subgroups of patients with node-negative and node-positive disease, OS and DFS also did not significantly differ between groups with respect to number of nodes resected (p > 0.05). A total of 49 (20%) patients developed recurrent disease; however, recurrence was not statistically associated with number of LN resected (p > 0.05).
  
  
  CONCLUSIONS
  We found no impact of extent of lymphadenectomy on overall or disease-free survival in patients treated with esophagectomy without neoadjuvant therapy. In addition, the number of nodes resected at esophagectomy did not affect recurrence rates. Current recommendations for increased nodal resection during esophagectomy in patients not receiving neoadjuvant therapy may not improve patient outcomes, and this phenomenon warrants further investigation.
authors.affiliation: Department of Gastrointestinal Surgery, H. Lee Moffitt Cancer Center, Tampa, FL, USA. joyce.wong02@gmail.com
authors.forename: Joyce
authors.initials: J
authors.lastname: Wong
authors.forename: Jill
authors.initials: J
authors.lastname: Weber
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoffe
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Richard
authors.initials: R
authors.lastname: Karl
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000368:Aged; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome